Post op complications

Question 1

Called post-op surgery- ask nurse

Answer 1

waht kind of surgey did patient have and what day postop is it?

Question 2

post op atelectasis common after

Answer 2

mechanical ventilation

Question 3

msot common cause of post operative death

Answer 3

pneumonia

Question 4

if atelectasis goes untreated post-op, can lead to

Answer 4

pneumonia

Question 5

pna tx

Answer 5

double coverage

Question 6

pulmonary causes of fever post-op

Answer 6

atelectasis, pna, acute respiratory failure, PE

Question 7

if patient does not have dysuria but have post op fever, do you still do UA?

Answer 7

YES

Question 8

UTI can cause post op fever and more commonly occurs with

Answer 8

foley catheters, so early removal or not placing them in first place is best

Question 9

tx of surgical site infection post -op

Answer 9

superficial- I and D. Deep (intra abdominal abscess)- IR drainage or open debridement (necrosis, would breakdown)

Question 10

how long can it take for abscess to manifest

Answer 10

7-10 days

Question 11

patient presents 3 days post op with pyrexia, sweating, chills, cellulitis, dehiscence. suspect

Answer 11

would infection

Question 12

most common sites for peritoneal abscesses

Answer 12

subphrenic space, subhepatic space. also paracolic gutters, pelvix, periappendical or pericolic areas

Question 13

common drugs responsible for fever post op

Answer 13

abx, chemo drugs, dilantin,, barbiturates, quinidine, drug that can caues NMS

Question 14

post op cardiac complications can include

Answer 14

hypotension/hypertension, dysrhythmias, or MI

Question 15

most common cause of post op HTN

Answer 15

pain

Question 16

when is ichemica incidence highest

Answer 16

first 48 hours post op

Question 17

acute oliguria

Answer 17

urine output less than 0.5 ml/kh/hr OR less than 30 ml/hour

Question 18

low urine output categories

Answer 18

intrinsic or extrinsic (pre renal or post renal)

Question 19

most common etiology of low urine output

Answer 19

pre-renal disease

Question 20

pre-renal vs.. post renal disease causes

Answer 20

pre-renal d/t reduced blood volume (external fluid loss from hemomrrhage, dehydration, diarrhea) or (internal fluid loss from pancreatitis, bowel obstruction, third spacing). post renal- d/t obstruction from BPH, stone, tumor

Question 21

hypotensive, tachycardic, low urine output, think

Answer 21

hemorrhage

Question 22

low urine output tx

Answer 22

if pre-renal give 500-1000 cc NS or LR over an hour, monitor for volume overload. if post-renal, manage obstruction- bladder scan and foley

Question 23

lasix and pressors in managing low urine output?

Answer 23

avoid. pressors- unless in septic shock

Question 24

postop intestinal obstruction can be

Answer 24

mechanical or functional

Question 25

return of bowel function time frame

Answer 25

small bowel- 24 hours, stomach- 48 hours. large bowel- 72 hours (assuming there was not intestinal surgery or obstruction present)

Question 26

factors that worsen/prolong post op ileus

Answer 26

narcotics, electrolyte abnormalities, pain, inflammatory conditions

Question 27

workup if ileus is suspected d/t abscess

Answer 27

CT

Question 28

workup if concern for mechanical obstruction

Answer 28

SBFT

Question 29

tx of ileus post op

Answer 29

Time! NPO, IVF, NG decompression ONLY if patient vomits, TPN if ileus lasts more tahn 3-4 days

Question 30

if pulse rate goes up when BP goes down

Answer 30

hypovolemia

Question 31

if pulse rate and BP both go down

Answer 31

vasovagal

Question 32

if you cannot get post op pain controlled, consider..

Answer 32

antra-abdominal disaster, esp if there are lab abnormalities (WBC, LA, lipase)

Question 33

post op complication of bleeding- what labs to order

Answer 33

CBC, urine output, vital signs

Question 34

pain control post op

Answer 34

PCA, bolus trick

Question 35

post op complications possible

Answer 35

post op fever, cardiac complications, low urine output, renal failure, ileus and obstruction, bleeding, post op pain